Ritalin Gone Wrong

[dcarrigg]

Re: Ritalin Gone Wrong

Don't believe me? Look up amphetamine... Methamphetamine...

Methamphetamine is sold as a prescription in the U.S. under the brand name Desoxyn. It is usually considered a step up from Ritalin/Adderall, which is itself an amphetamine salt. It is prescribed for ADHD and related symptoms as well as weight loss.

It is also crystal meth, that stuff featured on that show COPS - the only real difference is that high-school dropouts can make it in trailers more cheaply than Ovation Pharmaceuticals apparently can, and Lord only knows how they do that.

Methamphetamine was the most prescribed drug in the 1800s in the U.S. and was handed out for everything from sleeplessness to insomnia and from obesity to anorexia. Perhaps it is making its triumphant return in the 2000s.

We've managed to make medicine a lot more expensive. But whether it has gotten a lot smarter is certainly questionable, especially for psychiatric issues. It's still some combination of trial and error, what makes the patient feel good, and cost-benefit analysis. More art than science some might say. But if it's working for you, you may as well go for it. If not, send it away.

But if you're the type to resist giving children a glass of wine with dinner, but wouldn't bat an eye at handing them amphetamine, I might suggest you take these pills a little more seriously.

[don]

Re: Ritalin Gone Wrong

Cocaine is the drug of choice (and dependency need) when kids "outgrow" their ADD prescriptions, usually when their parental medical coverage ends.

[Spartacus]

Re: Ritalin Gone Wrong

Cocaine is the drug of choice (and dependency need) when kids "outgrow" their ADD prescriptions, usually when their parental medical coverage ends.

because of the outgrow I assume this was responding to me

Wang's position is they outgrow the ADHD if given no Ritalin.

[tmicou]

Re: Ritalin Gone Wrong

Here is Dr. Hallowell's (one of the most respected ADHD experts on the planet) response to the Sroufe article: Dr. Hallowell’s Response to NY Times Piece “Ritalin Gone Wrong. Note that Hallowell agrees with much of the article, but not the inflammatory rhetoric, nor the knee-jerk tone that implies that the drugs are almost always "bad".

-T

[don]

Re: Ritalin Gone Wrong

There is a context to the above. We have all seen some of Big Pharma's actions, including pushing drugs that actually worsen the condition they're supposed to address, concealing the fact, skewing and burying testing that runs counter to marketing, hiring physicians to the point they become shills of the industry, settling for large but in reality pennies on the dollar lawsuits, capturing the regulatory agencies, including the DSM, which has exploded seemingly exponentially in prescribed treatment symptoms - grieving for a lost love one is rumored to be on the list. Are there honest drug prescribers? Of course. Are there honest people in the banking industry. Of course. In the more egregious cases we need criminal prosecution, not just civil, much like in the financial. That would get someone's attention.

[Chris Coles]

Re: Ritalin Gone Wrong

There is a context to the above. We have all seen some of Big Pharma's actions, including pushing drugs that actually worsen the condition they're supposed to address, concealing the fact, skewing and burying testing that runs counter to marketing, hiring physicians to the point they become shills of the industry, settling for large but in reality pennies on the dollar lawsuits, capturing the regulatory agencies, including the DSM, which has exploded seemingly exponentially in prescribed treatment symptoms - grieving for a lost love one is rumored to be on the list. Are there honest drug prescribers? Of course. Are there honest people in the banking industry. Of course. In the more egregious cases we need criminal prosecution, not just civil, much like in the financial. That would get someone's attention.

Very well put. +1

[lakedaemonian]

Re: Ritalin Gone Wrong

It's not just Ritalin we needlessly(in many, but not all cases) pump into our children.

It's adults as well.

We left the US permanently 12 years ago....in that time so much has noticeably changed in Pharm....but I doubt most would notice living within it.

EVERY friend/family member that visits us rave about Ambien or whatever the pill of the moment is to improve their lives.

It's my understanding that sleeping pills like Ambien have exploded into a near $10 billion market.

Don't get me started on the slick S.A.D., Seasonal Affective Disorder.....just pop a Paxil, Zoloft, or a reformulated and recycled off patent Prozac.

Synthetic "solutions" to artificially created problems.

Soma and THX1138 come to mind.

Don't get me wrong.....there are truly some pharmacological miracles for sustaining life and the quality of it......but few things provide me peace of mind than knowing my family and I live debt and drug(legal or otherwise) free.

[jk]

Re: Ritalin Gone Wrong

Cocaine is the drug of choice (and dependency need) when kids "outgrow" their ADD prescriptions, usually when their parental medical coverage ends.

'fraid not. the mechanism is indeed the same, but i've never seen a patient with add or adhd who liked cocaine. frankly, they usually don't get any subjective pleasure from stimulants, and often they find them a bit uncomfortable. those who've tried cocaine say it just makes them sleepy. the data says they grow up at high risk for alcohol and drug abuse, but more likely downs or opiates in my experience. it's worth knowing a bit before making assertions. otoh, i suppose we can just state our prejudices and assumptions as if they were facts. who's to know the difference, eh?

[jk]

Re: Ritalin Gone Wrong

Don't get me started on the slick S.A.D., Seasonal Affective Disorder.....just pop a Paxil, Zoloft, or a reformulated and recycled off patent Prozac.

i was very skeptical about s.a.d. and the use of light therapy for many years, but some excellent research out of the national institute of mental health finally convinced me that it was worth considering seasonal treatment with high intensity, broad spectrum lights. there is definitely a component of the population who experience seasonal mood swings*- sometimes just sluggishness without a lot of subjective depression, accompanied by increased sleep and appetite. for some just getting some morning sunshine will be helpful. for others a light supplement does wonders. if those don't work, i'd suggest bupropion, a stimulating dominergic and noradrenergic antidepressant, often taken bypeople with seasonal mood problems just from oct through february or so (in the northern hemisphere). ssri's, such as you mention, are less likely to be helpful. i've had a few patients with chronic depression but seasonal exacerbations, whose seasonal component was controlled with adjunctive lithium.

again, i suggest to all that you learn something about these subjects before displaying your prejudices. also, you need to be aware that humans constitute a diverse population, and there are people who experience things that you may be blessed to avoid.



* note, too, that the incidence of depression, alcoholism and suicide all correlate with latitude.

[don]

Re: Ritalin Gone Wrong

The following review article is an excellent compilation of studies up until 1995 examining the relationship between ADHD and self-medication, particularly with cocaine. Please keep in mind that there has been a great deal of research on the nature of ADHD since that time, but nonetheless, the article is supportive and informative about the strong relationship between AD/HD and substance abuse. For many years, I have been working with individuals who had been diagnosed as "cocaine addicts" and were resistant to substance-abuse treatment. After a comprehensive evaluation, I am usually able to diagnose many of these individuals with ADHD. Although they were unaware of this while they were using, they were clearly using cocaine to self-medicate. The general response is that it "made me feel normal!"

Even though some of them were still actively using cocaine, they were put on a stimulant medication to treat their ADHD, and at the same time educated and counseled about ADHD and substance abuse. Most of them quickly lost their desire to use cocaine and have remained substance-free.



Dr. Ron Weinstein

The Self Medication Hypothesis:
ADHD & Chronic Cocaine Abuse
A Literature Review
By Daniela Plume B.A / April, 1995

---

TABLE of CONTENTS:

Introduction

Self Medication Hypothesis: A Brief Overview

Cocaine Abuse: The Self Medication Hypothesis
Sub-Types of Cocaine Users

Attention Deficit Hyperactivity Disorder (ADHD) & Cocaine Abuse:

Attention Deficit Hyperactivity Disorder (ADHD)
Epidemiology
Diagnostic Criteria
Genetic Factors
Diathesis Stress theory & Outcome Studies
Comorbid disorders

Cocaine Abuse:

A Brief History and Epidemiology
ADHD in Cocaine Abusing Populations
Characteristics of Substance Abusers with ADHD

Diagnostic Issues:

Retrospective Diagnoses & Confounding Variables
ADHD,Anti-social personality disorder & Conduct disorder
Causal Relationship between Substance Abuse and Psychopathy
Non-Specific Confounding Variables: the 3rd Variable Problem
Methodological Issues

Criticisms of the Self Medication Hypothesis
Case Studies
The Duel Diagnosis: ADHD & Substance Abuse
Ritalin Abuse Concerns
Conclusions

full report: http://www.addcentre.co.uk/selfmedcocaine.htm

[jk]

Re: Ritalin Gone Wrong

if you visit that fellow's website, addcentre.co.uk, you'll see it's full of the sort of self-promotion and marketing that makes me wary.

the report on cocaine abuse itself, written by someone else, references several researchers whom i've met personally: herb kleber, a former teacher of mine; mark gold and bruce rounsaville- colleagues; myrna weissman, a researcher now at columbia iirc, formerly at yale. the "paradoxical" effect of cocaine on people with adhd, as described therein, refers to the fact that they don't get high on cocaine. i suppose in theory there may be individuals who self-medicate with cocaine in this way; it would work. otoh, it's both far more dangerous [because you don't really know what the product is that you're purchasing] and far more expensive than getting a prescription from a licensed treater. also, as i've emphasized and as embodied in that word "paradoxical", the lack of subective high means it is not directly reinforcing so, aside from the illegality, it would be hard in that case to call it "abuse."*

i've worked with a somewhat different population than most of the researchers quoted. their research is done in clinics with poorer people who have fewer social supports than the population i've seen. i suppose that means they have less access to legitimate treatment, and more access to street cocaine, so some of these "self-medicators" might indeed exist. it is less than clear how this supports your - to my eyes- somewhat hysterical denunciations of the diagnosis and its treatment.


*in abuse you see escalating use, which won't happen with these "paradoxical" users, and you see impairment of function, while to the contrary these "paradoxical" users will see enhanced function.

[don]

Re: Ritalin Gone Wrong

Seems as if many of these physicians are robust self-promoters. Visiting Dr. Hallowell's site was a trip to the mall as well.

[jk]

Re: Ritalin Gone Wrong

Seems as if many of these physicians are robust self-promoters. Visiting Dr. Hallowell's site was a trip to the mall as well.

i don't know these individuals, nor have i looked at the content of their websites, but in general, unfortunately, some health issues seem to attract treaters who are more marketers than clinicians. there's one doctor, for example, who has started a national chain of self-pay p.e.t. scan centers focused on add and adhd. i asked a friend who is a senior scientist at the nimh and a world-level expert in brain imaging what he thought, and he said that that work wasn't accepted at all.

but don't throw out the baby with the bath water. the fact that hucksters may be involved doesn't mean the diagnosis or treatment is all b.s. there are people peddling bogus cancer cures. unfortunately, nonetheless, there's still cancer.

[don]

Re: Ritalin Gone Wrong

Unfortunately eliminating opportunists doesn't cure diseases. If only it was that easy

[flintlock]

Re: Ritalin Gone Wrong

Let me give you a perfect example of creative, engaging education.

In seventh grade my history teacher allowed the entire class re enact American history from the revolutionary war to the present (on certain conditions - we had to sign a contract). We "wrote" the declaration of independence, we "fought" the wars (wars were tests, either oral or written), we wrote legislation, we debated slavery and formed our own taxes, roads and foreign policy. We formed our own companies and wrote our own newspapers. we ran our own banks and accumulated our own wealth. We were required to provide historical context and justification to all of our actions, and if we went off the rails the teacher would intervene and put us back on course (one class voted to keep slavery).

Why is this such a novel concept? Why is stuff like this not used more often?

Why are our schools so ineffective and boring? Most boys (and many girls too) view school as punishment.

Because they treat education as a TOP DOWN enterprise. Which makes everything boring and inflexible.